Dr. Leana Wen

emergency physician, public health leader, patient advocate

The 8 Pillars to Better Diagnosis


Being an active participant in your healthcare is the key to avoid misdiagnosis. But how, exactly, do you actually advocate for yourself, especially when you are sick and have a pressing problem to address? In the last section, you saw some examples of what you can do when you are seeing your doctor to establish a partnership and become an active participant in your own healthcare. In this chapter, we condense the pitfalls and suggestions into the “8 Pillars to Better Diagnosis”.

How on earth can I remember 8 Pillars, you may ask. Especially because the times I would use these are when I’m sick—or when a loved one is sick! This is why we believe in practice and preparation. You need to learn and practice the 8 Pillars now so that you will be prepared when you have to use them.

Be warned: learning the 8 Pillars is not going to be easy. Most of us have spent so long thinking of medical care as a passive process that it takes time to change our mindset to put ourselves in the driver’s seat. At your own pace, we encourage you to read the Prescriptions for Patients in Chapter 14 as well as Appendix 2, which contains 21 exercises for practicing the 8 Pillars now so that you will be prepared for your next ER visit, doctor’s check-up, or hospital stay. Appendix 3 contains 2 sets of Worksheets that further help you organize your story. The Prescriptions give you tangible how-tos, and the exercises should help build confidence and provide guidance for when you or your loved ones need the right diagnosis.

Pillar #1: Tell your whole story
The story forms the foundation of diagnosis. Telling it may be an uphill battle, because the doctor, nurse, and tech may all be trying to steer away from a narrative and toward the cookbook world of “chief complaints” and close-ended questions. However, it is critical that you insist on telling your story. Work on becoming a better storyteller, and make sure that your doctor understands your whole story.

Pillar #2: Assert yourself in the doctor’s thought process
Your doctor is thinking about something while she’s with you. Assert yourself in her thought process early on. Find out what your doctor is thinking as she is taking your history. Let her know that you want to be integrally involved in coming up with your diagnosis and in every step of your care.

Pillar #3: Participate in your physical exam
Participating in the physical exam is an excellent way to be establish rapport and partnership, and for you to better understand your own body. As your doctor examines you, ask him what he is looking for. Make sure you understand the meaning of abnormal findings. Clarify how the findings confirm (or not) your doctor’s thought process.

Pillar #4: Make the differential diagnosis together
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Pillar #5: Partner for the decision-making process
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Pillar #6: Apply tests rationally
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Pillar #7: Use common sense to confirm the working diagnosis
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Pillar #8: Integrate diagnosis into the healing process
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The mortar on which all these pillars are built is communication. You need to speak up and be your own best advocates. Throughout the book, we have seen examples of strong, professional woman and men who are outspoken in every aspect of their lives, except when it comes to their own medical care. Many articles have been written on how trying to be the “good” patient actually leads to inferior care.
Medical care is not a popularity contest. If you don’t think your doctor understands you; if you don’t think your story is being heard; if you don’t agree with a part of your care; if you have questions that are not being answered—this is a problem, and you have to be the one to address it.

Incorporating the 8 Pillars to Better Diagnosis into your life will be as much an adjustment for your doctor as it will for you. Initial reactions from doctors may range from puzzlement to outright resistance. Don’t be discouraged; keep in mind that the age-old aphorism that practice makes perfect applies to the 8 Pillars to Better Diagnosis as much as it does for learning a new language or picking up a new sport—if anything, it may be even more difficult, because it requires a significant shift in mentality, on your part and on your doctor’s. One thing is for sure: your actions will be noticed and they will have an impact. Practice the prescriptions and try the exercises now, before you are sick and become trapped by a system that is dangerous to your health.

Read more:
Table of Contents
Jerry’s Story (excerpt from Chapter 3)
Danielle’s Story (excerpt from Chapter 5)
Advice For Patients (excerpts from Chapter 14)

Please visit our Advice For Patients section. lease visit my blog, Facebook site, and book website. Follow me on Twitter. Make sure to order your copy of When Doctors Don’t Listen today!